Folliculitis

Question 1

Define folliculitis

Answer 1

A superficial infection of the hair follicles, which develop into small inflammatory papules or pustules (pimples)

Question 2

Aetiology of folliculitis

Answer 2

Bacterial: Staphylococcus aureus
Long-term abx (e.g. in acne): gram -ve organisms (klebsiella, enterobacter, protus)
Hot tub folliculitis: Pseudomonas aeruginosa
Fungal: malassezia, candida
Viral: herpes simplex, varicella zoster, molluscum contagiosum
Demodex folliculorum
Eosinophilic folliculitis: sterile, arises in immunosuppression e.g. HIV

Question 3

Symptoms and signs of folliculitis

Answer 3

Papules and pustules
Anywhere but soles and palms

Question 4

management for folliculitis

Answer 4

Uncomplicated → self-limiting, does not require medical intervention
Advice:
- Antibacterial soaps e.g. chlorhexidine-containing solutions
- Loose clothing
- Wash skin with benozyl peroxide
Medical:
- Treat the cause e.g.:
- Topical antibiotics for bacteria e.g. dicloxacillin, clindamycin
- Special variants, such as Gram-negative folliculitis following prolonged antibiotic therapy for acne, or hot tub folliculitis (caused by Pseudomonas), may necessitate a different approach, tailored to the specific situation.

Severe: PO antibiotics

Eosinophilic - specialist referral/consultation

Question 5

Complications of folliculitis

Answer 5

Abscess
Sepsis
Scarring

Question 6

Prognosis for folliculitis

Answer 6

Excellent prognosis when the infectious agent is accurately identified and appropriately treated
Progression to systemic infection is rare in immunocompetent individuals
Superficial folliculitis due to infection with Staphylococcus aureus often recurs even after appropriate treatment
For fungal folliculitis, topical therapy alone may be effective initially but the recurrence rate is high,